139 / 290
[2] Rockwood,
et al.
(2005). Fit for Frailty: Consensus best practice
guidance for the care of older people living with frailty in
community and outpatient settings. British Geriatric Society
(2104).
P-389
Is cognitive frailty
“
functional sarcopenia
”
?
D. Wilson, T.A. Jackson, E. Sapey, J. Lord.
Institute of Inflammation and
Ageing, University of Birmingham
Introduction:
Sarcopenia is defined as low muscle mass (LMM) and
low muscle strength (LMS) or poor physical performance (PPP);
with low muscle mass being considered a pre-requisite and severe
sarcopenia present when all three parameters are positive. Cognitive
frailty is the presence of both physical frailty and mild cogni-
tive impairment (without dementia). We hypothesised that cognitive
frailty would impact on physical performance, causing a state of
“
functional sarcopenia
”
.
Methods:
Muscle mass (bilateral quadriceps ultrasound), muscle
strength (hand grip strength), physical performance (timed 4
metre walk), and cognitive impairment (Addenbrooks Cognitive
Examination) were documented in 33 highly characterised >65 yr
olds. Participants were divided into four groups: normal muscle mass
(NMM) and normal cognitive function(NCF)(n = 11), NMM and
cognitive impairment(CI)(n = 4), Low muscle mass (LMM) with NCF
(n = 11), LMM and CI(n = 7).
Results:
NMM and CI and LMM and CI had similarly poor physical
performance outcomes (number of falls, distance walked out-
side, short physical performance battery) while NMM with NCF and
LMM with NCF had similarly high scores across all these performance
outcomes. For example mean distance walked; NMM + CI = 88 m +
43; LMM + CI = 91 m + 44; NMM + NCF = 7455 m + 981; LMM + NCF =
7918 + 1004. Differences could not be explained by age.
Conclusions:
Mild cognitive impairment is associated with poor
physical performance, causing a state of
“
functional sarcopenia
”
in the
absence of low muscle mass. The mechanism linking these conditions
is unclear but inflammageing can impact both on muscle strength and
cognitive ability. Ultimately this may provide a pathway to severe
sarcopenia.
P-390
Ultrasound echogenicity is a better predictor of strength and speed
than age
D. Wilson, T.A. Jackson, E. Sapey, J. Lord.
Institute of Inflammation and
Ageing, University of Birmingham
Introduction:
Muscle quality is increasingly recognised as impor-
tant as muscle size in sarcopenia. Ultrasound echogenicity, reported
as a grey-scale value (GSV), is significantly associated with intramus-
cular adipose tissue [1]. We hypothesised that muscle quality (grey-
scale value) would be an important tool to diagnose sarcopenic
obesity.
Methods:
Participants were recruited to three groups: healthy
younger adult s(HY < 35 yrs; n = 16), healthy older adults (HE >65 yrs,
no chronic inflammatory diseases, n = 9) and frail older adults
(FE >65yrs, positive Frailty Index, n = 6) [2]. Participants were
extensively clinically characterised including bilateral ultrasound
image capture of the thigh using an established protocol [3].
Results:
The three groups had significantly different GSV (HY-
57.5 + 3.7; HE-54.2 + 8.7; FE-41.2 + 6.4; p = 0.037) with the FE group
being significantly lower than the HY group (p = 0.029). The GSV
correlates with adjusted hand grip strength significantly (R =
−
0.566,
p = 0.002) and adjusted walk speed (R =
−
0.374, p = 0.055) when
controlling for age. This correlation is far stronger than the correlation
of adjusted muscle depth with adjusted hand grip strength (R = 0.003,
p = 0.986) and adjusted walk speed (R = 0.02, p = 0.944) when con-
trolling for age. GSV do not correlate with BMI or adjusted subcuta-
neous tissue depth (BMI r -124, p = 0.5; adjusted subcutaneous tissue
depth r 0.031, p = 0.867).
Conclusions:
We have demonstrated that ultrasound echogencity is a
predictor of strength and speed when controlling for age. It is also a
better predictor than muscle size. Intramuscular adipose tissue is
neither related to BMI nor adjusted subcutaneous tissue depth.
These data suggest an assessment of sarcopenia should include a
measure of intramuscular adipose tissue. Further studies will be
needed to confirm this finding.
References
1. Reimers
et al.
, 1993.
2. Mitnitski
et al.
, 2001.
3. Strasser
et al.
, 2013.
P-391
Associations between frailty and no prescription of anticoagulant
therapy among older inpatients
Y. Yamada, T. Kojima, Y. Umeda-Kameyama, S. Ogawa, M. Eto,
M. Akishita.
Department of Geriatric Medicine, University of Tokyo,
Graduate School of Medicine
Background and Purpose:
Preventing embolic cerebral infarction is
important since it decreases activity of daily living and quality of life
in old people. However, appropriate use of anticoagulants is difficult
in frail old people because of increasing risk of bleeding events. Thus
the present study examined the association between no prescription
of anticoagulant therapy and frailty in older inpatients.
Methods:
835 patients aged
≧
65 who were admitted to the geriatric
ward of The University of Tokyo Hospital between 2013 and 2015 were
enrolled. 100 patients (men 48%, mean age 84.4 ± 7.4 years) had atrial
fibrillation. Comprehensive geriatric assessment was performed and
frailty was evaluated by BMI, IADL scale and Barthel index, MMSE,
vitality index, GDS15, and by living alone or not.
Results:
Among them, 44% were taking anticoagulant therapy. On
univariate analysis, higher age, lower body mass index, vitality index,
IADL and Barthel index were significantly associated with no prescrip-
tion of anticoagulant therapy. On multiple logistic regression analysis,
older age and higher BMI were associated with no prescription of
anticoagulant therapy, independent of other factors that were signi-
ficantly associated in univariate analysis.
Conclusions:
In older inpatients with atrial fibrillation, lower BMI, a
component of physical frailty was associated with no prescription of
anticoagulant therapy. Further studies are needed to clarify the
medical appropriateness of prescription of anticoagulant therapy.
P-392
Feasibility of general medicine to make an assessment of frailty in
patients who are over 65 years old. Regarding a prospective study
over a three-month period.
A.A. Zulfiqar
1
, A. Martin-Kleisch
2
, A. El Adli
3
, R. Vannobel
2
, C. Lukas
2
,
M. Dramé
4
.
1
Department of Internal Medicine-Geriatrics-Therapeutics,
University Hospital of Rouen, Rouen,
2
Department of General Practioner,
University Hospital of Reims,
3
Department of Emergency Care Unit,
University Hospital of Reims,
4
Research and Innovation Unit, University
Hospital of Reims, Reims, France
Our aimwas to find out if SEGA/Fried scores were applicable to general
medicine. Prospective study carried out. For each patient and before
calculating frailty scores, the general practitioner and the intern
assessed the presence, or not, of frailty and of the quality of aging. 38
patients were included. The average age is 78.3 years. The average
Fried score is 1.9. As concerns frailty, according to SEGA, the non-frail
represent 17 patients (44.7%), the pre-frail are 4 patients (10.5%) and
the frail 17 patients (44.7%). According to Fried, the non-frail account
for 9 patients (23.7%), the pre-frail in 17 patients (44.7%) and the frail in
12 patients (31.6%). For the concurrence of Doctor vs. SEGA and Doctor
vs. Fried, the assessment of the concurrence shows an excellent
agreement (Kappa = 0.8924) in relation to the SEGA score, whereas
this agreement is moderatewith Fried
’
s score (Kappa = 0.4627). For the
concurrence Intern vs. SEGA and Intern vs. Fried, we find once again an
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S133